Tuesday, 13 August 2013

An essay, published a couple of weeks ago
by the novelist Will Self, caught my eye because it embodies an interesting
conflict between two differing left-wing critiques of corporate capitalism.
They appear to be making diametrically opposite points yet both stem from an
anti-capitalist viewpoint, or at least display a healthy scepticism towards the
“truths” of our corporate society.

Self, who
has previously been a psychiatric patient, was concerned to take on the psychiatric
profession and (as the stand-first puts it) its “disease mongering”. Unable to
cure severe mental pathologies, Self argues, psychiatry has instead turned to
treating “less marked psychic distress”. Aided and abetted at every stage by
pharmaceutical companies, doctors now create diseases to fit the drugs
available. What used to be ordinary sadness has been rebranded as depression, an
illness that can conveniently be combated by the prescribing of
anti-depressants- a dispensing of
billions of pills to correct an alleged chemical imbalance in the brain that
coincidentally makes fantastic profits for big pharma.

“The sad
are becoming oddly co-morbid (afflicted with the same sorts of diseases) with
the mad,” writes Self.

Selfish capitalism and
it discontents

Contrast
this with the claim by Mark Fisher,
author of Capitalist Realism, that
neo-liberal capitalism is generating a “mental health plague”. Depression is
now the condition most treated by the National Health Service in Britain, says
Fisher. According to clinical psychologist Oliver James the “selfish capitalism” of Anglo-Saxon
societies is causing an acute intensification of emotional distress ; an
epidemic of depression, anxiety, substance abuse and personality disorder. James
cites World Health Organization surveys: 26% of Americans experience an episode
of “mental distress” every year. In Britain, the number is one person
in five.

Here is
James speaking:

So one side
identifies a contagion of mental illness, while the other says it’s all a plot
to uphold the prestige of psychiatry and supply pharma corporations with a
steady profit stream. Who’s right?

At the risk
of being diagnosed with an incurable case of fence sitting, it seems to me that
both of these positions, on the surface utterly incompatible, may be true.

Depression x 1000

There is
undoubted evidence for the veracity of what Self is saying. The arrival of
Prozac and other SSRIs in the late 1980s coincided with a thousand-fold
increase in the diagnosis of depression. It would be extremely difficult to
honestly argue this had nothing to do with efforts of drug companies to market
anti-depressants. And this initial anti-depressant spurt has since become a biblical
flood. In 2011, 46.7 million prescriptions were written for anti-depressants by the National Health Service in England,
an increase of 9.1% on the previous year, and an avalanche of pills compared to
the 9 million prescriptions signed off in 1991. But though “psychic distress” - to use Self’s
term - has clearly been turned into chemically treatable depression, that
doesn’t mean the distress was a fiction, or that the distress hasn’t increased,
or that it was simply sadness given a medical name. There is, it seems to me, a
large space between sadness and full blown mental illness. And a lot has been
happening, in the last twenty or thirty years, in that space.

Ordinary and
extraordinary sadness

Self
himself makes the distinction. “But what has made it possible for
someone recently bereaved or unemployed,” he asserts, “to have a prescription
written by their doctor to alleviate their ‘depression’ is, I would argue, very
much to do with psychiatry’s search for new worlds to conquer, an expedition that
has been financed at every step by big pharma.”

Bereavement and unemployment are, I would argue, two
completely different states. Bereavement is ordinary, though it doesn’t feel
ordinary, sadness. It’s impossible to go through life and not be bereaved and
feel its emotional effects. Unemployment is, by contrast, very much a socially
constructed state. In the first place, unemployment has only been around for
200 years or so. Secondly, it’s much more acute now than it was forty years ago
(from 1950 to 1973, UK
unemployment averaged 1.6%). Lastly, its effects on an individual depend very
much on how society treats it. Post-capitalist economists such as Richard Wolff
and David Schweickart have argued that, in a more humane society, people that
have to be laid off by enterprises would automatically be offered jobs or
training elsewhere. This is everyday practice now in the Mondragon federation of
worker co-operatives, comprising 256 companies employing 83,000 people, located
in Northern Spain.

By contrast, what British society does is to make
unemployment the personal responsibility of the person who is unemployed.
Unemployment – a social problem if ever there was one - becomes an individual
problem. The result is self-blame and, in a society that is intensely
comparative, all the ingredients for mental distress, not just sadness, are
laid. It is interesting that the root causes of the emotional distress
identified by Oliver James in 2008’s The
Selfish Capitalist (a book written before the financial crisis) –
stagnating real wages, the growth of short-term, service industry jobs (see the rise of
zero-hours contracts) and an exaltation of the consumer habits of the rich –
have only become more prevalent. So why shouldn’t mental anguish have got
worse?

Diseases, disorders and effects

The key to understanding what has happened, I think, is to
separate social effects from their pathologisation, the turning of states of
mind and behaviour into a “disease” which can then be treated by drugs. This
pathologisation may be entirely unjustified, just suiting the need of pharma
companies to make lots of money from selling pills, and indeed the pills may
not actually work (Self says that the chemical imbalance theory of depression,
on which SSRIs are based, is “essentially bunk” – he may be right, I don’t
know) But all that doesn’t mean the social effects are not real. “The vast
number of ‘hyperactive’ children in the US prescribed Ritalin is so well
attested that it’s become a trope in popular culture,” writes Self. True, but
I’m not convinced that labeling trends as a medical disorder, means that the
trends themselves – difficulty in concentrating and impulsive behaviour in this
case – are not genuine. Likewise, I don’t believe that the rise in mental
distress is a myth.

Valium nation

To take a historical example, millions of prescriptions were
written for the tranquilizer, Valium, a predecessor of anti-depressants, in the
1960s and 1970s. The drug quickly gained a reputation for being “the
housewives’ choice”. It provided a release from the psychic consequences of an
extremely restricted life. The problems for these women were pathologised and
the symptoms they suffered from chemically anesthetized. But that didn’t imply
that the underlying issues – a life limited to motherhood and caring and
confined to the home – didn’t exist, or that doctors somehow created them, as
most people, now the vast majority of women go out to work, would recognise.
Why can’t the same be said for anti-depressants?

The book, The Spirit Level, provides persuasive evidence that Anglo-American societies have
become more anxious, if not more depressed. The authors cite the work of
American psychologist, Jean Twenge, who looked at 269 studies measuring anxiety
in the US
from 1952 to 1993. She found a continuous upward trend. By the late 1980s, the
average American child was more anxious than child psychiatric patients in the
1950s. Anxiety, as far as I understand, is related to depression, though not as
extreme. You can’t explain away these findings by saying it’s all down to
doctors, egged on by pharma companies, discovering anxiety where previously it
didn’t exist. Prozac was first released in 1988, just five years before the
period of study ended.

I’ve little doubt that Self is right and psychiatry and big
pharma, have, for different reasons, created diseases and pathologised
distress. But that is only half the story.

Friday, 2 August 2013

In July a
college lecturers’ union in Britain released a survey of so-called ‘NEETS’- young people, aged 16 to 24 who are not in employment, education or training.
There are estimated to be 900,000 NEETS in the UK. One third of the 1,000-strong
sample said they had suffered from depression, 37% said they rarely left their
home and 39% were beset by stress. One jobless 23 year old told the BBC: “I
rarely go out and feel so down about myself. I’ve tried so hard to find a job
but I feel no-one wants me.”

According
to David Stuckler, co-author of The Body Economic: Why Austerity Kills,
Britain
is “one of the clearest expressions of how austerity kills”. Suicides were
falling before the recession, Stuckler relates in an interview. Then they
spiked in 2008 and 2009 as unemployment shot up, only to fall again when
jobless levels declined.

Unemployment,
it is clear, is terrible for your mental health; provoking feelings of
isolation, unwantedness and a corrosive sense of not contributing to society.
But unemployment – and underemployment - is a perennial blight in virtually all
advanced capitalist countries. With onset of the ‘Global Financial Crisis’, the
blight of joblessness has become chronic, reaching an eye-watering rate of 27%
in Spain and Greece.

Sinister consensus

So a
consensus has formed, in Britain,
as elsewhere, that sees joblessness as the enemy and employment as salvation.
Trade unions in the UK want stable and rewarding jobs, the British Labour party
now brands itself as “the party of work” while the ruling Conservative party,
in a move of cynical callousness, justifies the withdrawal of state benefits
from the disabled on the grounds of offering “tough love”to people stranded at home, doing nothing, in order to “help them into
work”.

There is
something inherently wrong, indeed sinister, with this myopic consensus, as I
hope parts oneand twomade apparent. Yet it derives its potency from a pervasive and genuine fear,
that of the destructive effects of non-activity. This fear becomes
all-consuming so that it is immaterial what work is for or what it entails, only that it exists. Zero-hour contracts –
where an employee does not know how many hours they will be contracted to work
in a given week – are mushrooming in Britain, while close to 80% of new jobs pay below £7.95 an hour (the minimum wage rate is £6.19). The overwhelming need is to be wanted by an
employer, to avoid the predations of unemployment, to not be excluded from
mainstream society. This consensus is both conservative and desperate.

Alternatives to
exhaustion

There are
innumerable advantages to the “organised diminution of work”, that Bertrand
Russell advocated in In Praise of Idleness.
Genuine choices would arise if your life was not dominated by the need to serve
the interests of another. More time to spend on caring, child-rearing, studying
or artistic endeavours, for example. It is not hard to compile such a list. A
healthier, more relaxed and more interesting society would result. Russell
himself estimated that at least one percent of the population – if not
distracted by the requirement to spend most of their useful hours on activities
designated by an employer – would produce works of public importance and
“since”, he argued, “they will not depend on these pursuits for their livelihood,
their originality will be unhampered”. It is, I feel, partly to block the
emergence of such original thinking, a bubbling and multi-pronged challenge to
mainstream explanations in economics and politics, that the boot remains firmly
planted on the neck, as far as working hours are concerned.

But there
is one activity which is both enabled by a radical reduction in working hours
and also has the potential to substitute for the cohesive side effects of paid
employment. I am speaking of democratic self-management. The English economist,
Harry Shutt, has said that “in the absence of productive work opportunities …
potentially the human race could rediscover the opportunity to practise direct
democracy somewhat in the manner of the ancient Athenians – but without their
need to depend on slaves to do all the menial work.”

Time for democracy

There are
many modern forms of direct democracy – participatory budgeting, worker self-directed enterprises,
citizen assemblies, random selection. They are all based on the idea that
ordinary citizens have the competence
to run their own affairs and that an outsourcing of power to representatives is
not necessary for good governance. But what they require to thrive is an
abundance of time. Genuine democracy is not possible in a time-pressed, hurried
society. Democracy, to work, has to be learnt by experience, by practising it.

A famous
ancient Athenian, Aristotle, remarked that excellence was a habit, not an act.
You become good at something, he said, by doing it repeatedly. Democracy, in
its classical sense, is not a habit for people in modern societies. When it
does appear, sporadically, its practices have to be learnt all over again and
fitted in with all the other demands of life. Work, by contrast, is a habit and
one we are loath to shake off. Management is a habit, careers are a habit,
consumption is a habit. The modern capitalist economy has been described as a
“gigantic school” doting on and encouraging some skills and allowing others to
atrophy.

Contrasting
the practices of Athenian democracy with modern notions of politics, the social
ecologist Murray Bookchin,
wrote: “The ‘political process’, to use a modern cliché, was not strictly
institutional and administrative; it was intensely processual in the sense that
politics was an inexhaustible, everyday ‘curriculum’ for intellectual, ethical
and personal growth – paidea that
fostered the ability of citizens to creatively participate in public affairs.”

The promise of
idleness

Some people
may find the word “curriculum” vaguely threatening but I think it is very apt.
If work is to fade in significance, as it is doing and will surely continue to
do, then its associated blessings – a sense of belonging, validation and of
making a contribution to society – will have to be replaced by something. The
fear of a void of non-activity needs to be assuaged. We need a society attuned
to post-scarcity, in contrast to this one which is in flagrant denial. John Maynard Keynes, writing in 1930, said the abiding problem for people once the economic problem had been solved,
would be what to do with their freedom, how exactly to occupy their abundant
leisure. Keynes, who was irredeemably elitist, could not answer his own
question.

We,
however, can. Democratic self-management, in my opinion, is both enabled by a
post-scarcity society and vital to such a future society’s inner strength. The UK
government, backed by the opposition Labour party, wants to create a “nation of
entrepreneurs”. A genuine Left movement should have the opposite endeavour, to
create a “nation of self-managers”, even if the phrase sounds horribly clunky.
Once that commitment is made, through forms such as participating budgeting,
citizen assemblies, participatory commissioning or worker co-ops, then the process,
as Bookchin recognised, becomes as important as the end point. Skills such as
public speaking, formulating positions, dissensus,
disagreeing with the opinions of others whilst respecting them, need to be
learnt and, as objectively as possible, taught. What passes for the Left
nowadays seems only to know what it is against and cannot encapsulate what it
is for. Economic stagnation and austerity has only further exposed this
deficiency. The promise of idleness should be recognised as an opportunity to
fill the vacuum.

About Me

Capitalism is not beautiful, said John Maynard Keynes. It is not intelligent, it is not virtuous and it not just. “But when we wonder what to put in its place, we are extremely perplexed.”
This blog is about the ideologies that mask the ugliness and injustice beneath the surface. And how our perplexity might be diminished.
You can contact me at idealogically@gmail.com